Menetrier's Disease

Menetrier's disease is an idiopathic condition characterized by excessive mucus production, giant mucosal hypertrophy, hypoproteinemia, and hypochlorhydria (due to the loss of parietal cells). In Menetrier's disease gastric rugae are typically wider than 25mm and sometimes polypoid in appearance - the diameter of normal folds does not exceed 5mm. The gastric body is most commonly affected, with frequent involvement of the fundus; the antrum is typically spared. Males are more commonly affected than females by a ratio of 2:1.

Patients typically present with epigastric pain, vomiting, and weight loss. A common sequela of the disease is protein-losing enteropathy with hypoproteinemia and peripheral edema. Menetrier's disease increases the risk of the development of gastric carcinoma. The diagnosis must be established by endoscopic biopsy because it is difficult to distinguish radiographically from lymphoma and other etiologies that cause mucosal hypertrophy (differential for enlarged gastric folds).

Radiographic Findings: UGIS

• Enlarged and serpiginous rugal folds in the body and fundus secondary to glandular hyperplasia and hypertrophy

• The folds may be poorly visualized secondary to poor adherence and dilution of the oral contrast agent by excess mucus

• Antral sparing (vs. lymphoma which preferentially occurs in the antrum)

Radiographic Findings: CT

• Proximal gastric wall thickening

• Large and symmetric nodular or cerebriform folds

A. UGIS images from three different patients with Menetrier's disease demonstrate the variable extent of gastric wall thickening. Features common to all include enlarged gastric folds in the fundus and body with antral and pyloric sparing. Folds are most notable along the greater curvature as marginal irregularities and at contrast interfaces. Figures A2 and A3 demonstrate small areas of contrast dilution with poor adherance due to hypersecretion.